ABSTRACT | The purpose of this paper is to raise awareness of and begin to build an open dialogue regarding nurse suicide. Recent exposure to nurse suicide raised our awareness and concern, but it was disarming to find no organization-specific, local, state, or national mechanisms in place to track and report the number or context of nurse suicides in the United States. This paper describes our initial exploration as we attempted to uncover what is known about the prevalence of nurse suicide in the United States. Our goal is to break through the culture of silence regarding suicide among nurses so that realistic and accurate appraisals of risk can be established and preventive measures can be developed.
When I was in the third year of my medical residency, I was asked to evaluate a new state-of-the-art, fully accessible exam table that would be used in doctors’ offices to better provide care for patients with mobility-related disabilities. The table could go as low as 18 inches off the ground to enable easier transfers for wheelchair users and had extra rails and grips to provide support for patients with impaired balance. I was to assess this equipment as a “user expert.” Although the table was designed
When I was in the third year of my medical residency, I was asked to evaluate a new state-of-the-art, fully accessible exam table that would be used in doctors’ offices to better provide care for patients with mobility-related disabilities. The table could go as low as 18 inches off the ground to enable easier transfers for wheelchair users and had extra rails and grips to provide support for patients with impaired balance.
I was to assess this equipment as a “user expert.” Although the table was designed to accommodate patients with disabilities, I rolled up to it to evaluate it from the perspective of a physician. “Do you want my opinion as a patient, or as a doctor?” I asked the surprised representatives from the medical equipment company.
I have been a wheelchair user since early childhood, when I sustained a spinal cord injury in a farming accident. I am now a practicing physician in the field of rehabilitation and sports medicine.
In my busy outpatient clinical practice, I witness the spectrum of patients’ reactions when they find out that their doctor is, herself, disabled. Typically those first few seconds after entering an exam room — before the patient’s guard goes up — are the most informative.
I find that these reactions are somewhat generational. Younger patients, having grown up amid a growing awareness of disability in society, typically do not react at all. They have clearly encountered empowered people with disabilities working in various professional roles. Older patients often seem confused, curious or, in rare circumstances, dismayed.
Several months ago, I wheeled into the room of an elderly woman. She looked at me, placed her hand on mine and, with a kind look asked, “Are you an invalid?” More recently, a jovial older man exclaimed, “You’ve got to be kidding me!” A few times, patients will hesitate to tell me their concerns, indicating “Well, doc, I feel bad complaining about this to you, when clearly your problems are bigger than mine.”
Several years ago, while in my residency, I was in line at our hospital cafeteria. Although my badge reading “Dr. Blauwet” and stethoscope were clearly visible, a man next to me in line said: “You look like you are doing pretty well. When are you going to be discharged?” Clearly, my wheelchair was the only thing he saw. Moreover, he equated my wheelchair with illness, rather than empowerment.
Over the years, I’ve thought a lot about situations like these, and I do not believe they come so much from direct prejudice as from people’s lack of experience with doctors who are also wheelchair users. A recent study revealed that less than 3 percent of medical school trainees are people with disabilities, and of these, only a small proportion are individuals with mobility impairment. How can we expect our patients or colleagues to know about the perspectives and needs of physicians with disabilities when we remain invisible to them? The reason for this underrepresentation is complicated. Most physicians with mobility disabilities will tell you that the problem is not that we lack the ability to do our job competently. As with many other educated, skilled professionals, we know how to choose a path that suits our talents and abilities. Reasonable accommodations, such as the use of standing wheelchairs in the operating room, give us the access we need to do our work. The larger barrier to entry for prospective doctors with disabilities, however, is bias, both overt and hidden.
A colleague who is quadriplegic recounted a medical school admissions officer telling him, “I’m afraid that you will not meet the technical standards for admission.” Although steeped in bias and probably illegal, this response was at least more direct than the more common form of discrimination where otherwise strong applicants with disabilities simply do not receive an interview or a call back. As our peers are accepted into prestigious schools and academic positions, we sit on the sidelines, left to question whether the fault lies with us or the system. Many give up their aspirations of a career in medicine altogether, electing to pursue work more “traditionally suited” for people with disabilities. Others lose sleep, questioning whether it was the right decision to disclose their disability in the application materials.
Anyone can enter, at any time, the minority group of people with disabilities. The most common cause of new, adult-onset disability is — simply put — aging. Physicians are often reluctant to disclose new-onset or progressive disability (like loss of hearing or vision, or reduced mobility) because of the fear of being stigmatized; medicine, after all, is still dominated by the prototype of physical prowess.
Dr. Lisa Iezzoni, a professor of medicine at Harvard Medical School, has been an important mentor to me for many years. She recounted her experience as a medical student at Harvard in the early 1980s, a decade before the passage of the Americans With Disabilities Act. In her first year at the medical school, after experiencing some physical and sensory symptoms, she was given a diagnosis of multiple sclerosis. Late in her third year, after a fall, she started using a cane, but her aspirations to pursue an internal medicine residency remained, despite the overt discouragement she received. At a student-faculty dinner, an influential professor told her: “There are too many doctors in the country right now for us to worry about training a handicapped physician. If that means someone gets left by the wayside, that’s too bad.”
The medical school refused to write a letter of recommendation for her residency application, so she could not pursue the training required for clinical practice. She pursued health policy research instead and became the first female professor of medicine at the Beth Israel Deaconess Medical Center and now directs the Mongan Institute Health Policy Center at Massachusetts General Hospital. Despite having had an extraordinarily successful career, she sometimes wonders what could have been if she had been able to practice medicine.
My experience, more than two decades later, was vastly different. As an undergraduate at the University of Arizona, I became interested in applying to medical school. I investigated the application process and took coursework that would set me up for success. I studied, networked, did internships and engaged in various activities that would strengthen my application. Additionally, throughout this time, I nurtured my alter ego as an athlete, pursuing the sport of wheelchair racing, and ultimately represented the United States in three Paralympic Games.
In the fall of 2002, I applied to medical school, received interviews at several prestigious universities and was accepted to the Stanford University School of Medicine. Throughout this process, I never once feared that my disability would get in the way of success. I could focus on my academic performance rather than expending mental energy around concerns of hidden bias.
As a member of the “A.D.A. generation,” I was blissfully ignorant that my visible disability could, in fact, derail my success. I simply assumed that I would be evaluated on merit, like my peers. (I also realized that my athletic success perhaps made me seem more “able.”) I now understand the privilege of that perspective. I cannot completely separate my disability identity from my professional role.
People with disabilities often express fear or dissatisfaction with our health care system because they face poor access and discriminatory attitudes. This must change. Perhaps having more doctors with disabilities is one solution. As with any underrepresented group in medicine, professional diversity should reflect our population’s diversity. That simple change can bring awareness, empathy and a shared experience that ultimately makes all of us better.
Cheri A. Blauwet (@CheriBlauwetMD), an assistant professor at Harvard Medical School, is a seven-time Paralympic medalist and serves on the board of the United States Olympic Committee.
Disability is a weekly series of essays, art and opinion by and about people living with disabilities.
The entire series can be found here. To reach the editors or submit an essay for consideration, write email@example.com and include “Disability” in the subject field. Follow The New York Times Opinion section on Facebook and Twitter (@NYTOpinion), and sign up for the Opinion Today newsletter.
Professionalism: Working and Training with a Disability Just How Far Have Attitudes Evolved?
Dealing with severe bilateral sensorineural hearing loss is straightforward enough for Regina Troxell, MD, now in her fifth year as a child neurology fellow at Memorial Hermann in Houston: She relies on a hearing aid and lip reading to communicate. But, she said, dealing with some of her colleagues is sometimes somewhat more complicated.
“If an attending says something when we’re rounding and I don’t hear because there’s background noise in the hallway, or they’re not facing me, it can become an issue,” Dr. Troxell said. “A couple of times it has come up during evaluations, where they wrote, ‘I don’t know if she didn’t hear what I told her or just didn’t do it.’ Maybe they’re not comfortable asking me at the time of the event because it’s a disability.”
Getting misunderstood or underestimated has been a near-universal experience, said neurologists and other physicians who happen to have disabilities in interviews with Neurology Today. The physicians and medical students — who discussed a wide range of disabilities, from hemiparesis, multiple sclerosis, and cerebral palsy to spinal injuries and hearing loss — said handling their disability is often easier than handling their fellow physicians’ biases. But there are signs that progress has been made toward greater acceptance, they said.
Baltimore hospital settles allegations of disability discrimination with $180,000 payment | Legal Newsline
BALTIMORE (Legal Newsline) — The U.S. Equal Employment Opportunity Commission (EEOC) announced April 27 that Harbor Hospital Inc., trading as MedStar Hospital, will pay $179,576 after allegations of federal disability discrimination.
“Health care providers, like all employers, must be mindful of the obligation to provide a reasonable accommodation that allows an employee with a disability to remain employed,” said EEOC Philadelphia district office director Spencer H. Lewis Jr. “It’s not only a good employment practice to retain loyal and productive workers; it’s required by federal law.”
According to EEOC, MedStar Harbor Hospital violated the Americans with Disabilities Act (ADA) when it fired Jerome Alston, a respiratory therapist, because of his disability. Alston had had a kidney transplant and needs to take medications. These medications weaken his immune system. Alston asked for a “work-around” accommodation, so that he would not have to work in isolation rooms with a mechanical ventilation system designed to trap infectious airborne materials. MedStar did not grant him the accommodation and fired him instead, EEOC said.
“An employer must provide a reasonable accommodation to an employee with a disability such as renal failure, whether it is needed because of limitations caused by the disability itself or by the side effects of medication or treatment for the disability,” said EEOC regional attorney Debra M. Lawrence. “We are pleased that MedStar Harbor Hospital took these claims seriously, cooperated in resolving this matter, and agreed to make meaningful policy changes to ensure that its employees and applicants are protected from disability discrimination and receive the accommodations to which they are entitled under the ADA.”
Since she was a young girl, Li Juhong dreamed of becoming a doctor. Then, at 4 years old, she lost her legs in a tragic and painful accident. But that experience didn’t weaken Juhong’s resolve; rather, it drove her to help others in pain. Now, the 38-year-old is one of two doctors responsible for around 2,000 people in the mountainous Chinese village of Wadian. Armed with her medical training and a determination that often sees her work well into the night, Juhong says she feels “happy and lucky” to have helped so many people in her village.
Marks, B. & McCulloh, K. (2016). Success for Students and Nurses with Disabilities: A Call to Action for Nurse Educators, Nurse Educator, 41(1), 9-12. doi: 10.1097/NNE.0000000000000212.
This article presents a ‘‘call to action’’ for nurse educators to identify and implement best practices supporting the success of students with disabilities given recent federal legislative changes. Best practices for educating students with disabilities in nursing education are discussed. Increasing our understanding of disability from a variety of models—not just the medical model—will promote greater diversity and inclusivity within the nursing profession, which will enhance patient care.
Just and Realistic Expectations for Persons with Disabilities Practicing Nursing, Oct 16 – AMA Journal of Ethics
The nursing profession can become more inclusive by fostering a supportive culture, resilience, and realistic expectations for people with disabilities. AMA Journal of Ethics is a monthly bioethics journal published by the American Medical Association.
Patricia M. Davidson, PhD, RN, Cynda Hylton Rushton, PhD, RN, Jennifer Dotzenrod, MPP, Christina A. Godack, MA, Deborah Baker, DNP, CRNP, and Marie N. Nolan, PhD, RN
The Americans with Disabilities Act prohibits discrimination on the basis of disability and requires schools to provide reasonable accommodations for persons with disabilities. The profession of nursing is striving for diversity and inclusion, but barriers still exist to realizing accommodations for people with disabilities. Promoting disclosure, a supportive and enabling environment, resilience, and realistic expectations are important considerations if we are to include among our ranks health professionals who can understand, based on similar life experiences of disability, a fuller range of perspectives of the patients we care for.
Technical Standards and Deaf and Hard of Hearing Medical School Applicants and Students: Interrogating Sensory Capacity and Practice Capacity, Oct 16 – AMA Journal of Ethics
Medical school technical standards should be revised to be more inclusive of applicants with disabilities to diversify the physician workforce. AMA Journal of Ethics is a monthly bioethics journal published by the American Medical Association.
Michael Argenyi, MD
Applicants to medical schools who are deaf and hard of hearing (DHoH) or who have other disabilities face significant barriers to medical school admission. One commonly cited barrier to admission is medical schools’ technical standards (TS) for admission, advancement, and graduation. Ethical values of diversity and equity support altering the technical standards to be more inclusive of people with disabilities. Incorporating these values into admissions, advancement, and graduation considerations for DHoH and other students with disabilities can contribute to the physician workforce being more representative of the diverse patients it serves and better able to care for them.
Why Increasing Numbers of Physicians with Disability Could Improve Care for Patients with Disability, Oct 16 – AMA Journal of Ethics
Expanding the numbers of physicians with disabilities would facilitate patient-centered care for those who need similar accommodations. AMA Journal of Ethics is a monthly bioethics journal published by the American Medical Association.
Lisa I. Iezzoni, MD, MSc
Erroneous assumptions among health care professionals about the daily lives, preferences, values, and expectations of persons with disability can contribute to documented health care disparities, faulty communication, and substandard quality of care affecting this heterogeneous population. Efforts to reduce racial and ethnic disparities have focused on expanding diversity in the physician workforce. Would expanding the numbers of physicians with disability benefit patients with disability? Increasing the number of physicians who identify as “disabled” is one strategy for proactively confronting disability-related barriers affecting patients, but such efforts will likely face substantial challenges. Nonetheless, physicians who require accommodations to practice (e.g., a height-adjustable examination table) could plausibly benefit patients needing similar accommodations and perhaps be well-positioned to provide patient-centered care to persons with comparable disability.
Theme issue: Health Professionals with Disabilities. AMA Journal of Ethics is a monthly bioethics journal published by the American Medical Association.